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In-Depth: Vaccine expansion causes concern for doctors

Supply issues, exceptions leave doctors in doubt
Posted at 6:10 AM, Feb 25, 2021
and last updated 2021-04-18 22:59:25-04

SAN DIEGO (KGTV) -- Doctors in San Diego worry that expanding COVID-19 vaccine eligibility too fast could lead to unintended consequences.

"When you increase the pool by so many people, it's going to be a crunch for those of us vaccinating to serve all these people," says Dr. Christian Ramers of Family Health Centers of San Diego.

He says his clinics typically only get 20-30% of the vaccines they ask for, and supply may not keep up with demand as the state and San Diego County allows more people to get vaccinated.

Gov. Gavin Newsom says teachers, police officers, food service workers, and other essential employees will become eligible on March 1. Then on March 15, people ages 16-64 with certain preexisting health conditions will be allowed to get their shot.

RELATED: San Diego County to open vaccine eligibility to people with certain health conditions in March

Dr. Ramers says there won't be enough vaccine supply to go around.

"I've had patients come to me and say, 'I know I'm going to get vaccinated on March 15th because the governor said so.' And that's a little bit divorced from reality because of the scarcity of our supply," Dr. Ramers says.

Shortages and delivery delays caused closures at several vaccine sites in early February. The county is also prioritizing second shots right now. Dr. Ramers thinks adding hundreds of thousands of San Diegans to the list of eligible recipients will cause a "mad blitz" on vaccines in the first two weeks of March.

Vaccine developers say they're working to increase supply. On Tuesday, Pfizer's Chief Business Officer John Young told Congress that his company will deliver 13 million doses per week across the country. Moderna President Dr. Stephen Hoge said his company will double supply to 40 million doses per month by April. The FDA could also approve the Johnson and Johnson vaccine within the next few days.

But even if supply increases, doctors say they'll face another problem of having to decide who gets the vaccine and when. The Public Health Bulletin from the state listed ten specific underlying conditions that would become eligible on March 15.

RELATED: Questions surrounding the California variant

But it also says doctors can use their "clinical judgment" to assign vaccines to other people who are at risk of severe health problems or death because of COVID.

Dr. Ghazala Sharieff, the Chief Medical Officer for Acute Care at Scripps, says that language is too vague to be practical.

"You might as well not have criteria," Dr. Sharieff says. "You might as well just say everyone 16 to 64 if that's the case because I can almost guarantee you there's an out for almost everybody."

That "out" gives hope to many people who have severe health problems that aren't included in the conditions listed, including people with Type 1 Diabetes, Lupus, Hypertension, and more.

Janet Silva, the Director of Community Outreach for the Lupus Foundation of Southern California, says she hopes that exemption can help people like her get a vaccine sooner rather than later.

"Lupus is an autoimmune deficiency that attacks many people in very different ways," she says. "I'm a cardiac patient. I have a stent. I have breathing issues at times. And it scares me. How is that less important than a kidney?"

While important, Dr. Sharieff says that exemption places an unnecessary emotional burden on doctors who will have to field thousands of calls from people with severe conditions asking for a vaccine. The doctor will ultimately have to decide who should and shouldn't get vaccinated.

"It's going to be very hard for the physician to say, 'No,' because that leeway is in there," she says.

Dr. Ramers, however, says it's "fair" to let a doctor decide what's best for their patient.

"I think in the end, it is a good thing," he says. "We don't want to increase restrictions. We want to increase vaccinations."

The state has also offered little guidance in how to enforce the new guidelines. Doctors will have to write letters for their patients to present at mass vaccination clinics, proving they are eligible under the new guidelines.

Scripps Health and Family Health Centers are already looking through their patient records to contact people whose conditions will make them eligible on March 15th.

Still, all of that depends on supply.

"I would ask our patients to continue to be patient," says Dr. Sharieff. "The patient and patience can go together. And that's how it's been."